In guidelines, the American Society for Gastrointestinal Endoscopy is suggesting that blacks begin colonoscopy screening at age 45.
It is a suggestion, not a recommendation, which would carry a greater weight, according to the ASGE's Standards of Practice Committee, which developed the guidelines (Gastrointest. Endosc. 2010;71:1108-11).
The recommendations are based on literature reviews; the word “recommendations” means that the quality of evidence was greater, while a “suggestion” indicates that the quality was weaker.
The authors noted that “African Americans with colon cancer have a 20% stage-adjusted increase in mortality risk, compared with European Americans,” are younger at presentation, have a higher proportion of cancers presenting before age 50, and generally, are of a more advanced stage at the time of diagnosis.
Many ethnic groups have low colon cancer screening rates; the guidelines recommend a new emphasis on screening for those groups.
Although there have been no studies that assess the impact of modifying specific endoscopic standards based on ethnicity, “it is logical to assume that increased awareness of differences in disease patterns and management among different ethnic groups could have beneficial impacts on the health-related quality of life of people in these groups,” said Dr. Jason A. Dominitz, chair of ASGE's Standards of Practice Committee, in a statement.
“At the same time, it is important to recognize that ethnic populations are not homogeneous and that additional factors, such as environment and behavior, also play important roles in disease,” he said.
The guidelines also suggest a screening esophagogastroduodenoscopy (EGD) for gastric cancer in new immigrants from high-risk regions, such as Korea, Japan, China, Russia, and South America, in particular if there is a family history in a first-degree relative.
However, screening EGD for adenocarcinoma or squamous cell carcinoma of the esophagus should be based on clinical considerations and not upon ethnicity, according to the guidelines.
The full guidelines can be found in the June issue of GIE at www.giejournal.org